Welcome to Susan's Place, Gerri!
Three weeks. I have a feeling each one is going to feel a lot longer than it should. You're probably feeling a dozen things right now — excitement, relief, maybe some nervousness about what comes next, maybe all of it at once. However it's showing up for you, that's exactly right. April 15th is a big day and just being able to say that out loud matters.
You've probably been carrying this a long time. Most of us who start later in life have. Decades of knowing, decades of pushing it down, decades of reasons why it wasn't the right time. And now it is.
You're 68 and you're doing this and I want you to hear this clearly — you are not too late. That thought is going to creep in. Someone online will say it, or a family member, or just that voice in the back of your head at 2am. It's wrong every time. HRT works at your age. The changes are real. Women here have started in their 50s, 60s, 70s and they will tell you the same thing — they wish they hadn't waited, but they're grateful every day that they finally started.
Your endo chose the patch, and that's a good call. Transdermal estrogen goes directly through the skin into the bloodstream, which means it skips the liver entirely. That matters at any age but it matters more for us because oral estrogen carries a higher risk of blood clots and puts more strain on liver function. Patches give you steady, even estradiol levels all day without the ups and downs you can get with pills. You're getting the safest, most consistent delivery method available.
Something that might help between now and April 15th — grab a notebook and start jotting down questions as they come to you. You'll forget them the minute you sit down in that office. Everyone does.
Things worth asking about: what dose they're starting you on, what estradiol level they're targeting — most endos aim for somewhere between 100 and 200 pg/mL but everyone has their own approach. How often they want bloodwork — expect every three months at first while they dial in your levels. They'll be checking estradiol, testosterone, liver function, metabolic panel, probably prolactin.
Whether they're planning to add an anti-androgen like spironolactone or whether they want to see how well the estrogen suppresses your testosterone on its own first. Either way is fine, but it helps to understand their thinking. And if they do prescribe spironolactone, ask about potassium — spiro is a potassium-sparing diuretic, so you'll need to stay well hydrated and be mindful of your potassium intake. Your bloodwork will keep an eye on it but it's good to know why.
Because you're 68, your endo will probably want some baseline numbers before you start — cardiovascular health, blood pressure, bone density. That's not a worry, it's just thorough care. And here's a nice piece of news: estrogen is actually protective for bone density. So while your doctor is being careful about monitoring, the HRT itself is doing your bones a favor.
And if you want help putting together questions specific to your situation, ask us here. Between the women in this community, we've probably sat through a few thousand endo appointments collectively. We know what to ask and what we wish we'd asked.
Once you've got that patch on, a few practical things that'll save you some grief. Lower abdomen or upper buttocks for placement — those areas absorb well and don't get as much friction from clothing. Clean the spot with rubbing alcohol and let it dry completely before you stick it on. No lotion, no moisturizer anywhere near it or it won't stay put.
Rotate your sites every time and give each spot at least a week before you come back to it, otherwise you'll get irritated skin.
And when summer hits and that patch starts peeling at the edges — because it will — Tegaderm transparent film dressings from the pharmacy over the top are a lifesaver. They'll keep everything in place through sweat, showers, everything. And if the adhesive leaves a sticky residue when you remove the patch, a little baby oil takes care of it.
Now the part you're probably most curious about — what's actually going to happen.
The first changes might surprise you because they probably won't be physical. A lot of women say the earliest thing they notice is emotional. Something opens up. Some women describe it as a fog lifting that they didn't even know was there. Others say it's like someone turned the color on after living in black and white. It can feel like finally exhaling after holding your breath for a very long time.
You might find yourself crying at things that never would have touched you before. You might feel a calm settle in that you can't quite explain. You might feel raw and overwhelmed some days. All of that is real and all of it is right. Testosterone dampens emotional range — you've been living behind that wall your entire life, and when it starts to come down, the world feels different. Let it. Don't fight it. It's one of the things women here talk about most when they describe what HRT gave them.
Physically, things move gradually. Softer skin comes fairly early — you'll feel it in your hands and face first. Body odor shifts, gets lighter and less sharp.
Within a few months, breast development usually starts with small buds behind the nipples. They will be tender, sometimes really tender, especially if you bump them. That's normal and it's a good sign. Development follows the same stages as any puberty and takes years, so be patient with it. Genetics matter here — the women in your family are a rough guide to what you can expect, though most trans women end up about a cup size smaller than their closest female relatives.
Fat redistribution is slow but it's one of the most significant changes over time. Your body starts laying down fat in your hips, thighs, and buttocks instead of your belly. Your face softens. It's cumulative and after a year or two, looking back at old photos can be startling.
Body hair gets finer, lighter, grows slower. It won't eliminate your facial hair though — that usually takes laser or electrolysis to really deal with, so it's worth looking into when you're ready.
You'll notice you're not as strong as you were. Muscle mass decreases as testosterone drops. You'll get cold more easily — keep a sweater handy because your internal thermostat is about to recalibrate. Your skin will bruise more easily and you'll want to moisturize more than you ever have. These are all just your body settling into its new normal.
There are sexual changes too, and nobody talks about them enough so I will. Libido usually dips at first, sometimes significantly. For a lot of women it comes back but it feels different — less like a drive and more like something connected to emotion and intimacy. Spontaneous erections typically decrease or stop. These changes can feel disorienting if you're not expecting them, so now you're expecting them.
Beyond all of that, you may find yourself thinking about things you didn't anticipate. How you want to express yourself — whether that's publicly or just in your own space for now. How and when, or even if, you want to share this with people in your life. What being yourself actually looks like day to day when you've spent decades not being allowed to find out.
None of that has to be figured out right now. You don't have to have all the answers. You don't even have to know all the questions yet. This unfolds at your pace, nobody else's.
If you don't already have a therapist experienced with gender identity, it's worth finding one. Not because anything is wrong with you, but because this is a meaningful transition in every sense of the word — the emotional changes from the hormones, the decades of feelings that may come flooding forward, the social dimensions of stepping into yourself after a lifetime of waiting. Having someone in your corner who understands this territory is a gift to yourself.
One more thing. Start taking photos now, before your appointment. Then take them regularly — same lighting, same angle. You won't see the changes day to day. You just won't. But when you put month one next to month six next to month twelve, you'll see exactly what the hormones have been doing. It's one of the most affirming things you can do for yourself, and almost every woman here says the same thing — I wish I'd started the photos sooner.
You found us, Gerri. This community has women who have been exactly where you are right now, counting the days to that first appointment, wondering what's coming, hoping it's not too late. It's not too late.
Come back and tell us how April 15th goes. Ask us anything. The only silly question is the one you don't ask because you were too shy.
Welcome home.
— Susan💜
